Pneumococcal carriage and antibiotic susceptibility patterns in mother-baby pairs in a rural community in Eastern Uganda: a cross-sectional study [version 3; peer review: 1 approved, 1 approved with reservations]

Background: Pneumococcal carriage predisposes children to pneumonia. Pneumonia poses a significant threat to the lives of children below five years old worldwide, contributing to a high number of hospitalizations and death. Morbidity and morbidity are especially common in children under five and the elderly, although any age group can be affected. This study aimed to estimate pneumococcal carriage and determine antibiotic susceptibility patterns of the pneumococci isolated from mother-baby pairs in Ngora district after the rollout of the pneumococcal vaccine. We hypothesized that high carriage of Streptococcus pneumoniae in mothers leads to carriage in their babies and hence a greater chance of contracting pneumonia. Methods: Consecutive sampling was used to select 152 mother-baby pairs from community visits and those seeking care at the health facility. We collected nasal swabs from both baby and mother for culture and sensitivity testing using Kirby-Bauer's agar disc diffusion method. Data was also collected from the mothers who consented to take part in the study, using an interviewer-administered questionnaire. Results: This study found that there was a low prevalence of pneumococcal carriage in the mother-baby pair in the Ngora district. Only one mother-baby pair (1/152) was found to be colonized with pneumococci in both mother and baby and the rest of S. pneumoniae colonized either the mother or baby. We also observed high rates of microbial resistance to penicillin, which is the first-line drug for the management of pneumonia in Uganda. Also, high resistance patterns were recorded with chloramphenicol (50%) and tetracycline (50%), whereas the lowest resistance was recorded in clindamycin (17%). Conclusions: The relationship between pneumococcal carriage and immunization status suggests that the pneumococcal vaccine is protective against the pneumococcal carriage. Resistance of S. pneumoniae to commonly used antibiotics was high.